2型糖尿病患者肾小球滤过率与尿白蛋白的关系

Relationship between glomerular filtration rate and urinary albumin excretion in the patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者慢性肾脏病（CKD）的患病率及肾小球滤过率与尿白蛋白排泄间的关系。方法收集自2008年1月至2009年12月在江苏省省级机关医院就诊的2型糖尿病患者资料,采用MDRD公式评估肾小球滤过率（eGFR）,CKD定义为存在白蛋白尿或者eGFR〈60 ml/（min·1.73 m2）。白蛋白尿定义为尿白蛋白/肌酐比值（ACR）≥30 mg/g。采用多项式回归及曲线拟合分析eGFR与尿ACR之间的关系。结果研究纳入1521例2型糖尿病患者,平均年龄（63.9±12.0）岁,CKD及白蛋白尿的患病率分别为31.0%和28.9%。eGFR≥90、60~89、30~59、15~29 ml/（min·1.73 m2）患者白蛋白尿的患病率分别为19.9%、34.5%、65.6%和100%。在正常蛋白尿、微量白蛋白尿及大量白蛋白尿患者中,肾功能不全的比率分别为3.0%、9.3%和40.4%。多项式回归分析显示当患者尿ACR〈90 mg/g时,eGFR下降缓慢且稳定保持在90 ml/（min·1.73 m2）以上,而当尿ACR≥90 mg/g时,eGFR则迅速下降。结论 2型糖尿病患者CKD及白蛋白尿发生率高,对2型糖尿病人群进行CKD的筛查应该同时检测尿白蛋白与eGFR,为了延缓CKD的进展,应尽早对白蛋白尿进行干预治疗。

Objective To explore the prevalence of chronic kidney disease（CKD） and the relationship between estimated glomerular filtration rate（ eGFR） and urinary albumin excretion in the patients with type 2 diabetes mellitus.Methods A cross-sectional study was conducted in Jiangsu Province Official Hospital from January 2008 to December2009. The Modification of Diet in Renal Disease（MDRD） study equation was used to calculate eGFR. CKD was defined as the presence of albuminuria or eGFR 60 ml /（min·1. 73 m2）. Albuminuria was defined as urinary albumin-to-creatinine ratio（ACR）≥30 mg /g. Polynominal regression and curve fitting were performed to estimate the decreasing trends of eGFR with the increment of urinary ACR. Results A total of 1521 type 2 diabetic patients（ mean age,63. 9 ± 12. 0years） were recruited. The prevalence rate of CKD and albuminuria was 31. 0% and 28. 9% respectively. The prevalence of albuminuria was 19. 9%,34. 5%,65. 6% and 100% in patients with eGFR≥90,60-89,30-59 and 15-29 ml /（min·1. 73 m2）,respectively. The frequency of renal insufficiency was 3.0%,9.3% and 40.5%,and the frequency of eGFR 90 ml /（min·1. 73 m2） was 40.4%,57.6% and 89.3% for patients with normo-,micro-and macro-albuminuria,respectively. In subjects with urinary ACR less than 90 mg /g,the level of eGFR decreased slowly and steadily and maintained more than 90 ml /（min·1. 73 m2）. However,eGFR decreased rapidly once the level of urinary ACR was over 90 mg /g. Conclusions This study suggests CKD and albuminuria are common in the patients with type 2 diabetes. Both parameters（GFR and urinary albumin） should be measured in screening chronic kidney disease in diabetic patients. In order to delay the progression of CKD,albuminuria should be treated as soon as possible.